Peter Hotez: Measles in America—what’s playing out in New York State is nightmarish

Eventually, this measles epidemic will be controlled, but we will almost certainly continue to see larger and more frequent measles outbreaks in the US

Measles has been mostly gone from the United States for almost two decades, but there are signs it might return. So far the New Year has not started well. As we enter the second quarter of 2019 there have been measles cases in more than a dozen states, including large outbreaks in the states of Washington, Michigan, and New York. Most of these cases of measles are a direct consequence of a decline in vaccine coverage due to sharply accelerating antivaccine advocacy activities on the internet, together with antivax outreach efforts focused on certain groups. It has also been blamed on complacency among parents who have never seen the disease and therefore don’t vaccinate their children against it.

The Rockland County, New York measles epidemic is now the largest this year, with 153 reported cases to date. It has mostly affected an orthodox Jewish religious group that may have been deliberately targeted by antivaccine groups, similar to how antivaccine activists ignited a prolonged measles epidemic among a Somali immigrant community in Minnesota in 2017. Unfortunately, the Rockland County epidemic is showing no signs of letting up and there are worries that it might continue for several more months.
There are several factors fueling measles in New York.

First, the measles virus is one of the most highly transmissible infectious agents of humans—this means that a very high percentage (typically 95%) of the area population must be immunized to prevent an outbreak. It also does not help that historically winter and spring represent the seasons of peak measles transmission in North America. On this basis alone, local and state public health officials need to work furiously to ensure that they make measles vaccine available to the affected community. So far 17,000 Rockland residents have been vaccinated during this current epidemic.

But there are also several key social determinants now blocking further measles control efforts in Rockland. Local health officials are reporting that the population at risk has now become defiant, in terms of not cooperating with local health officials. They’ve blocked the entrances to their homes and are not answering phone calls. We’re facing a situation in which the antivaccine lobby has become so dominant that parents may be refusing to vaccinate their children against measles even in the middle of a large and dangerous measles outbreak.

During public health emergencies, the state has broad powers to contain dangerous outbreaks like this one, including the power to quarantine households. However, quarantine is considered an extreme measure, and one not undertaken lightly. So as a stop-gap measure local health officials have taken the interesting approach of forbidding unvaccinated children (individuals under the age of 18 years) to enter public spaces, roughly defined as areas where 10 or more individuals might congregate.

Practically speaking the measures were taken to emphasize the seriousness of the Rockland epidemic and to persuade parents to vaccinate their children. However, they could also mean that if during an investigation of a measles case it is found that a child (or his or her siblings) was intentionally not vaccinated, the parents could be referred to the district attorney’s office for misdemeanor prosecution.

What’s playing out in New York State is nightmarish. The antivaccine movement now dominates the internet. It has the means, funds, and intent to prey on vulnerable communities like the one in Rockland and to use social media and e-commerce sites to convince them that vaccines cause autism or other conditions. The provaccine side is barely able to counter these arguments given how public health agencies and departments in the US are chronically underfunded, and with minimal capacity to mobilize their messages.

Eventually, this measles epidemic will be controlled, but we will almost certainly continue to see larger and more frequent measles outbreaks in the US. So far both the US Congress (through its recent hearings), state legislatures, and the leadership of the major social media and e-commerce platforms have made a few efforts to try and contain the American antivaccine movement. But too much of their focus has been reactive and mostly focused on optics rather than substantive action. Until then, we should expect further outbreaks of vaccine preventable diseases.

Peter Hotez is Professor of Pediatrics and Dean of the National School of Tropical Medicine, Baylor College of Medicine. He is also the author of Vaccines Did Not Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad (Johns Hopkins University Press)

Competing interests: PH is an inventor on (non-revenue generating) patents for neglected tropical diseases